慢性化脓性中耳乳突炎的手术治疗

既往治疗慢性化脓性中耳乳突炎首先考虑的是彻底清除病灶,对听力能否提高关注不够,尤其是青少年患者.现在的要求是在彻底清除病灶的同时,要提高听力、干耳率.     

提高中耳乳突炎的诊断与外科治疗水平

中耳乳突炎的诊断和治疗一直是耳科学的重要课题之一，随着现代数字影像检查、耳内镜、实时神经监测等新技术与多种新型植入材料在耳科学领域的应用，以及颞骨解剖课程和模拟手术训练的开展，使得近年来我国在中耳乳突炎的诊断与治疗方面取得了长足的进步。清除病灶和结构重建、保留和恢复功能已成为中耳乳突炎外科治疗的主流。2004年5月中华医学会耳鼻咽喉头颈外科分会和中华耳鼻咽喉头颈外科杂志编辑委员会在西安举办的中耳炎专题会议（以下简称西安会议），     

慢性中耳乳突炎手术的医源性并发症

对有经验的耳科医师,慢性中耳乳突炎手术常见并发症的发生率低于1％。本文重点讨论面神经损伤,其次为血管损伤,鼓室与鼓窦盖损伤,半规管损伤及迷路窗损伤。不包括中耳手术所致的颅内感染,脑水肿及其他脑神经损伤。     

联合径路鼓室成形术治疗慢性化脓性中耳乳突炎

１９９３年４月～１９９７年１２月采用联合径路行鼓室成形术治疗慢性化脓性中耳乳突炎３２例（３４耳）。经１～５年随访,疗效满意,现总结报告如下。１　临床资料３２例慢性化脓性中耳乳突炎（非胆脂瘤型）患者中,男１９例,女１３例,年龄１５～４６岁。病程４～２０年。经２年以上保守治疗仍反复流脓２８例,静止期４例。手术所见：中耳乳突粘膜水肿伴有肉芽２４耳,积脓７耳,息肉３耳;砧骨部分缺损９耳,锤骨部分缺损１１耳,砧骨、锤骨同时有部分缺损５耳,听骨完整、但部分被肉芽包裹９耳;鼓膜中央性穿孔２８耳,边缘性穿孔６耳…     

结核性中耳乳突炎

3例耳结核病人,均为白人女性,年龄不超过33岁,来自贫困的挪威地区,都没有结核接触史,仅1人有头、颈部表现。据该国家结核病登记处统计,1979～1988年间报道有3 273例结核病人,结核性淋巴结炎占4.8%,无淋巴结核的耳鼻咽喉侵害仅占0.33%(11例)。复习20世纪英文文献,有320例结核性中耳炎或中耳乳突炎,其中93例是1986～1990年中报道,其中83%(77例)来自贫困的非洲地区,至少     

外耳道胆脂瘤合并中耳乳突炎治疗方式探讨

目的探讨外耳道胆脂瘤合并中耳乳突炎及鼓膜穿孔的治疗方法。方法采用回顾性研究方法,分析40例外耳道胆脂瘤及其并发症的临床诊疗情况。术后随访半年-1年。统计学分析采用Fisher精确概率检验法分别检验中耳乳突炎和鼓膜穿孔手术处理方式的差异性有无统计学意义。结果 140病例均无胆脂瘤复发;2改良乳突根治术对合并中耳乳突炎的愈合情况无统计学差异(p>0.05,p=0.375);3鼓室成形术对合并鼓膜穿孔患者的鼓膜愈合情况无明显差异(p>0.05,p=0.426)。结论外耳道胆脂瘤合并中耳乳突炎及鼓膜穿孔者可先行胆脂瘤取出术,术后随访观察,如无治愈二期行改良乳突根治术和鼓室成形术。     

慢性中耳疾病的外科治疗

化脓性中耳炎急性期的治疗在处理感染性中耳疾病中占有重要地位。在芬兰五所大学的耳鼻喉科教学中都强调对所有急性化脓性中耳炎病例早期施行鼓膜切开术的重要性,认为鼓膜切开术能有效地加速治愈,阻止其发展成慢性;防止脓液向鼓窦和乳突气房蔓延,保证中耳氧分压增加,从而有利于咽鼓管口周围的粘膜水肿消退。对于反复发作过三次者,主张切除腺样体、上颌窦灌洗及置通气管。根据作者的经验,这样治疗效果很好,所有病人都获得痊愈。若中耳粘膜发展成分泌型、咽鼓管粘膜持续肿胀、乳突气房明显混浊或气化停止,应鼓励长期使用通气管治疗。若乳突区感染活跃、中耳液有菌、通气管有分泌物流出,如乳突照片有乳突气房破坏和肉芽性乳突炎的征象,应考虑做乳突凿开术。单纯乳突凿开术作者强调乳突凿开术应象乳突根治术一样彻底。所谓单纯只是指决不进入     

结核性中耳乳突炎的误诊原因探讨

目的：探讨结核性中耳乳突炎的临床特征并分析其误诊原因。方法：回顾分析9例结核中耳乳突炎的临床资料。结果：9例患者仅1例在术前明确为结核中耳乳突炎,其余8例术前误诊为慢性中耳乳突炎,术后病检才确诊为结核中耳乳突炎。结论：结核性中耳乳突炎临床特征与慢性化脓性中耳乳突炎相似,临床上易混淆。临床医生应重视此病,结合病史、影像学检查、病理检查及其他特殊检查以明确诊断,减少误诊。     

胆脂瘤型骨疡型中耳乳突炎外科治疗的合理选择

目的探讨并评价胆脂瘤型/骨疡型中耳乳突炎外科治疗的合理选择和术式改进.方法对61例(6 2耳)胆脂瘤型和/或骨疡型中耳乳突炎住院病例施行完整骨桥式乳突手术(intact-bridge tympanomastoidectomy,IBM),对原术式进行若干改进.开放上鼓室、鼓窦及乳突,切除骨性外耳道后壁、经面神经隐窝开放后鼓室.保留低位骨桥以维持中耳腔容积,去除不可逆病灶,同期或分期进行鼓室成形术. 结果随访12～38个月,其中51/ 62耳(82.2%)≥2年,干耳时间5～13周(平均6周).术后纯音测听气骨导差(air-bone gap, ABG)≤20dB HL 15/62耳(24.2%),21～30dB HL26/62耳(41.9%),≥31dB HL1 0/62耳(16.1%). 结论 IBM手术将开放式与闭合式技术相结合,兼备二者的优点,符合清除病灶并保存听力的耳外科原则,为慢性化脓性中耳乳突炎的外科治疗提供了又一合理的选择.     

胆脂瘤型骨疡型中耳乳突炎外科治疗的合理选择

目的 探讨并评价胆脂瘤型/骨疡型中耳乳突炎外科治疗的合理选择和术式改进。方法 对61例（62耳）胆脂瘤型和/或骨疡型中耳乳突炎住院病例施行完整骨桥式乳突手术（intactbridge tympanomastoidectomy,IBM),对原术式进行若干改进。开放上鼓室、鼓窦及乳突,切除骨性外耳道后壁、经面神经隐窝开放后鼓室。保留低位骨桥以维持中耳腔容积,去除不可逆病灶,同期或分期进行鼓室成形术。结果 随访12-38个月,其中51/62耳（82.2%)≥2年,干耳时间5-13周（平均6周）。术后纯音测听气骨导差（air-bone gap,ABG)≤20dB HL 15/62耳（24.2%),21-30dB HL26/62耳（41.9%),≥31dBHL10/62耳（16.1%).结论 IBM手术将开放式与闭合式技术相结合,兼备二者的优点,符合清除病灶并保存听力的耳外科原则,为慢性化脓性中耳乳突炎的外科治疗提供了又一合理的选择。     

Characteristics of recurrent chronic rhinosinusitis after previous surgical therapy

CONCLUSIONS: Our findings emphasize the role of a thorough diagnostic evaluation preoperatively and a targeted long-term medical therapy following any sinonasal surgery for inflammatory disease. Early onset of long-term aspirin desensitization can address a very predominant inflammatory stimulus in a large number of our patients in an effort to prevent recurrent chronic rhinosinusitis (CRS) after successful surgical therapy. BACKGROUND: Postoperative recurrence of CRS, regardless of the ongoing evolution of diagnostic and surgical techniques, still poses an unsolved problem. SUBJECTS AND METHODS: This investigation was designed to further characterize the role of aspirin intolerance (AI) and inhalant allergies as persistent inflammatory stimuli in the postoperative period and secondly to analyze the correlation between preoperative computed tomographic (CT) scores and the actual intraoperative findings. A total of 143 patients with recurrent CRS were included in this retrospective analysis, who all underwent revision sinus surgery at our institution after one or multiple previous operations. Charts were analyzed for the incidences of AI and inhalant allergies, CT scores, and intraoperative scores. RESULTS: In all, 66/143 patients had inhalant allergies and 55/143 were diagnosed with AI. The risk of recurrent CRS was found to be highest in the group with AI, along with the shortest interval between previous surgical interventions and the need for revision. In a subgroup of 34 cases, correlations between CT and intraoperative endoscopy scores were poor in 79%. Interestingly, at the time of recurrence the frontal sinuses were diseased in 17.6% of cases, where they had been healthy at the time of the initial intervention.     

Spontaneous retraction pockets in chronic otitis media medical and surgical therapy.

Results of a series of 228 spontaneous retraction pockets in chronic otitis media are reported and a classification is proposed. Under medical therapy, 78 retraction pockets of stage I and II (out of 95) were followed for five years. Sixteen percent deteriorated into stage III and were operated on; the others stabilized or improved towards normal tympanic membrane (23%). Different methods of surgical therapy were used in 150 retraction pockets (all the stages III and many stages II). Even with silastic sheeting and strengthening of the tympanic membrane, a recurrent retraction pocket was observed in 24 cases (16%). Functional results were obviously better when the ossicular chain was rebuilt from an intact malleus to an intact stapes and either from an intact malleus to a mobile footplate or from the tympanic membrane to an intact stapes. Surgery of retraction pockets must be used not only to prevent cholesteatoma formation but also to prevent erosion of the stapes.     

The surgical management of chronic parotitis

Chronic parotitis is a disorder characterized by recurrent painful swelling of the gland with purulent sialorrhea. Occasionally, the condition fails to respond to medical management and definitive surgical therapy is necessary. Sialolithiasis is the usual etiology in cases of parotitis, although occasionally severe recurrent parotid infections are superimposed on underlying Sj?gren's disease. Total parotidectomy with facial nerve dissection has been used in such cases in our department and has proved to be an excellent way to manage this disease. A summary of our results indicate that the recurring infections were eradicated and that the complication rate is tolerable, considering the magnitude of the problem. We feel that it is better to use surgical management early rather than wait for the formation of fistulae or abscesses.